Daycare provider Melissa Lawwell feeds Morgan Mueller before putting her down for a nap at her home in St. Joseph, Minn. on May 9. / Dave Schwarz, St. Cloud (Minn.) Times

by Kirsti Marohn, USA TODAY

by Kirsti Marohn, USA TODAY

ST. CLOUD, MINN. - Wrapped in a fuzzy blanket, Morgan Mueller's eyelids droop as she snuggles with day care provider Melissa Lawwell.

When it's time to lay the 10-month-old infant down for her afternoon nap, Lawwell takes away the blanket and lays her in an empty white-railed crib.

Having 15 years of experience operating a day care in St. Joseph, Minn., Lawwell knows and follows the rules for putting babies to sleep: Lay them on their backs in a crib with a tight-fitting sheet, no toys or blankets.

Minnesota is one of two states, along with Hawaii, to tighten sleep regulations for in-home day cares this year. Safe sleep practices have been at the center of a public policy debate in Minnesota since a report last year found a rising number of deaths of children in child care settings.

Studies show that children are more likely to die while at in-home day cares than child care centers, said Rachel Moon, director of academic development for the Goldberg Center for Community Pediatric Health at Children's National Medical Center in Washington and a member of the SIDS (Sudden Infant Death Syndrome) task force for the American Academy of Pediatrics.

Regulations for in-home day cares vary widely by state, Moon said. About two-thirds have some regulations relating to safe sleep, but the majority have loopholes despite evidence that such regulations can help reduce infant deaths, she said.

"Sometimes it takes a death or a few deaths for people to realize that it is an issue," Moon said.

Child care providers don't always follow the sleep recommendations because some babies will sleep longer on their stomachs, Moon said. There's also a misconception that a baby lying on its back might choke if it spits up. Child care providers are more likely to follow safe sleep practices if they're regulations, Moon said.

The Minnesota Legislature adopted requirements for in-home day care providers aimed at enforcing safe sleep practices, including requiring that providers take additional training and always lay babies on their backs in a crib to sleep unless a doctor's note says otherwise.

The Hawaii bill requires all day care providers and child care facilities that care for children younger than a year to adopt safe sleep policies, said Howard Garval, president and CEO of the non-profit Child & Family Service, which advocated for the requirement.

Garval said the bill resulted from a coalition called Safe Sleep Hawaii, formed in 2002 to address the serious problem of healthy infants dying suddenly because of unsafe sleep practices.

"I think it was just the recognition that this is such a preventable tragedy," Garval said.

Lawmakers have been reluctant to regulate in-home day cares, viewing them as independent business owners and the regulations as overly burdensome.

"A lot of things are changing about the expectation of the field, both from parents and from government," said Ann McCully, executive director of the non-profit Child Care Aware of Minnesota.

The Minnesota law includes an increase in the required training for day care providers from eight to 16 hours a year, including a course on safe sleep practices every year. Some providers don't object to the training requirements, saying they often exceed the required hours anyway.

"It's always a good reminder," said Katie Janssen, who has operated an in-home day care in St. Augusta, Minn. for 31/2 years.

Some proposals didn't make it into the final bill, including a requirement that providers check on sleeping infants every 15 to 30 minutes, depending upon the baby's age. That is a recommendation rather than a requirement.

Lawwell called that proposal impractical.

"They don't expect that from the parents of these children, so I don't think it's reasonable to expect it from the providers," she said.